RN-Case Management (Utilization Review)

Integrated Resources Inc

Job Title: RN - Case Management (Utilization Review)
Location: Bakersfield, CA - 93306
Duration: 13 Weeks with possibility of extension
Schedule: Mon-Friday 8-4:30

Job Summary
The RN Case Manager performs advanced utilization review and discharge planning activities to ensure appropriate patient care, compliance with payer requirements, and optimal reimbursement.

Responsibilities

Evaluate inpatient admissions for medical necessity
Conduct ongoing case reviews and recommend care adjustments
Develop and implement discharge plans
Coordinate with physicians and healthcare teams
Resolve payer and authorization issues
Educate providers on documentation requirements
Review elective procedures for authorization compliance

Requirements

Minimum 2 years RN experience in acute care (Page 2)
At least 1 year Med/Surg experience (Page 2)
Plus either:
- 1 year Utilization Review / Discharge Planning experience
- OR 2 years Case Management experience (clinic/physician office)
Active CA RN License
BLS certification
Strong knowledge of payer guidelines and documentation

Apply

Vacancy posted 2 days ago

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